Individual
GREGORY J DAVENPORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3500 N INTERSTATE AVE, PORTLAND, OR 97227-1196
(503) 331-6101
Mailing address
3500 N INTERSTATE AVE, PORTLAND, OR 97227-1196
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10003132
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8357766
—
WA
Enumeration date
06/05/2006
Last updated
07/23/2007
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